HomeMy WebLinkAboutBuilding Permit Application MAY-10-2017(WED) 12: 52 FORWARD ELECTRIC (FAX)772 221 3180 P. 001/003
ALL APPLICAB IN O MUST BE COMPLE'T'ED FOR APPLICATION TO BE ACCEPTED
Date: 0 7 Permit Number: `, CJ Is' 13 6
. = ° . ECER'779 MAY 112017
Building permit Application
Planning and Development Services
Building and Code Regulation Division
2304 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-5553 Fax:(772)462-1578 Commercial A Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
03 Cr
Address: c� ,t•y���'�r_�r"1 1��'. Fk1C_�C E' , y� _
Legal Description:
Property Tax ID#: 1� � �cJ' O�U�.. Ooo- 0 Lot No,
Site Plan Name: Block No.
Project Name: �C"G��]C7✓ -- -
Setbacks Front �y Back:_ . Right Side: Left Side:
''4JF 9 , n R l: R^ t Ii:J1 V' � j v � r •
U
15 5ekc
Additional work o be nerformed under this perms -check all appy:
HVACC�as7ank Gas Piping fiShutters OW[ndows/Doors
Electric 0 Plumbing Sprinklers Generator Roof . Roof pitch
Total Sq.Ft of Construction-
// S .Ft.of First Floor.
Cost of Construction:$ 7.�� O� Utilities: Sewer ESeptic Building Height:
FName 't-6CiC iC�L1S'ac\ �kP_ct9n �dy1 Name: �\kiG✓� t'Y1 CL✓ Ort
Address: _ Company:tY.,-G_•c� .1eGvi_C.�_ 1�-
City: State:�Z� Address:
W"'3. S_'- PC Vt
Zip Code: ".t a Fax: City State:- U-
Phone No. u\t.Q4g"�L7`�U Zip Code: Fax: aC) n_ _
E-Mail: Phone No. I LD C o o
Fill in fee simple Title Molder on next page(if different E-Mall:\J-.t LV%t 0 663.,,-e.-lGu i, eo/7�7
from the Owner listed above) State or County License: CA L
if value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
MAY-10-2017(WEO) 12: 52 FORWARD ELECTRIC (FAX)772 221 3180 P. 002/003
NNE MO.
DESIGNER/ENGINEER: _Not Applicable (MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone- Zip: Phone-
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name' Name:
Address: Address:
City: ._ City:
Zip: Phone: zip:_Phone: _
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorise the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,l do hereby agree that I will,in alf respects,perform the work
in accordance with the approved plans,the Florlda Bullding Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of commencement may result in-your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first•inspection. If you intend to obtain financing,consult with fender or an attorney before
commencing work or recording aur Notice of Commencement.
" S
Signature of Ow r/ essee/Contractor as Agent for Owner signature 15f Contractor License Holder
STATE OF FLORID STATE OF FLORIDA,{ '
COUNTY OF (�.. _ COUNTY OF /�Ctrn .
The f r g instru t was acknowledged before me, The for r g instrum n was acknowledged before me
this�y of 20 ,�y this�y of 20 by
(Nam of person acknowledging) (Name o pe son acknowledging)
rgna ure of ffotary Public-state afi Florida) ignature of Notary Public-st a of Morldb)
Personally Known V OR Produced Identifi n Personally Known OR Produced Identifica '
Type of identification Produced Type of identification Produced
Commission No. Isslon No.
GINA M:'KENYON , Y G NA'M:KENYON
Notary Pupiir.-state of arida ,`t; Notary Public-state of Florida
ommission =•, __-Commission
Revised 07/15/2014 , : My Comm.Expires Jul 25,.2420 '%yf' z My Comm.Expires Jul 25,2020
� Bonded through Nallonal Notary Assn: '••,Y;,;;•�` Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS